International Journal of Nursing Studies 52 (2015) 791–793
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International Journal of Nursing Studies
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Guest Editorial
On self-compassion and self-care in nursing: Selﬁsh or essential
for compassionate care?
Keywords:
Caring
Compassion
Nurse
Nursing
Self-care
Self-compassion
Compassionate care in nursing is increasingly an
international concern. While the literature to date has
focussed on redressing a compassion and care deﬁcit
across the nursing discipline (Crawford et al., 2014; Dewar
et al., 2014; Scott, 2014), we suggest here that due
consideration be given to its relationship to self-care and
self-compassion in nurses. After all, a deﬁcit in these
compromises nurses’ therapeutic use of self in the
provision of compassionate care to patients. As a noted
scholar and practitioner of compassion, the Dalai Lama
(2003, p. 125) argues that:
For someone to develop genuine compassion towards
others, ﬁrst he or she must have a basis upon which to
cultivate compassion, and that basis is the ability to
connect to one’s own feelings and to care for one’s own
welfare. . . Caring for others requires caring for oneself.
Compassion for others is surely a motivating factor for
most that join the nursing profession. Indeed it could be
argued that nursing care is synonymous with compassion.
However, the degree to which nurses balance this care by
extending compassion and care to themselves is given
little attention. While much has arisen from Orem’s selfcare deﬁcit theory (Wilkinson and Whitehead, 2009), there
is a dearth of literature on self-care for nurses. Research on
compassionate care is building momentum, but to date
few studies have focused on nurses’ self-compassion.
Fewer still have considered its relationship to nurses’ selfcare and care for patients. We thus feel it is timely to
discuss a broader perspective on compassionate care;
valuing the primacy of self-compassion and self-care, to
support nurses’ compassionate care for patients.
http://dx.doi.org/10.1016/j.ijnurstu.2014.10.009
0020-7489/ß 2014 Elsevier Ltd. All rights reserved.
Two seemingly distinct crises are discussed in the
recent nursing literature – a global workforce crisis (Van
den Heede and Aiken, 2013) and the ‘crisis in nursing care’
(Darbyshire and McKenna, 2013). Clearly, it is shortsighted to view these in isolation.
Given that nurses’ wellbeing and quality of care have
been shown to be interdependent (Maben et al., 2012), it is
not surprising that compassionate care for patients has
become a pressing issue. The impacts of occupational stress,
burnout, and compassion fatigue feature prominently in the
literature (Chang et al., 2007; Lee et al., 2012; Tucker et al.,
2012); as does workforce turnover and nurse shortages
(Hayes et al., 2012; Roche et al., 2014). Many nurses cope by
distancing themselves from patients (Mackintosh, 2007).
Whilst this has implications for the therapeutic relationship,
of greater concern, is the dehumanisation of patients by a
profession that espouses humanistic care (Maben et al.,
2012; Triﬁletti et
al., 2014). The nursing practice
environment is a key factor (Norman, 2013), but within
this environment nurses are, themselves, clearly in need of
self-compassion and self-care. Despite the centrality of
caring in nurses’ work, many nurses neglect self-care
(McAllister and McKinnon, 2009). Why is this so?
Richards (2013) asserts that self-care is vital and
beneﬁts both nurses and patients. Many might argue
however, that for nurses, any emphasis on self per se, is
contrary to the compassionate care of others. Self-care
could be seen to foster a culture of selﬁshness throughout
the nursing profession. Indeed, some have labelled selfcare practice as ‘responsible selﬁshness’ (Adam and Taylor,
2013), but this serves only to perpetuate the existing
stigma of self-care as selﬁsh (Rose and Glass, 2008). The
caring capacity of nurses, in a holistic sense, is questionable where nurses fail to care for themselves. Shapiro
(2008) highlighted metaphorically that the human heart
needs to ﬁrst pump blood to itself. This is further supported
by Watson’s (2008) Theory of Human Caring, in which
nurses’ care for self and others is interdependent, rather
than mutually exclusive. By practising self-care nurses can
better embody their role as exemplars for health promotion (Blake and Harrison, 2013; McElligott et al., 2009). But
792
Editorial / International Journal of Nursing Studies 52 (2015) 791–793
problems arise from a tacit understanding within nursing
that the act of caring, for self or others, is dichotomous. This
dichotomy and the lack of research evidence supporting
self-care undermine the growing emphasis on holistic
nursing care (Rose and Glass, 2008). Greater recognition of
the importance of self-care is required.
Richards (2013) argues that the practice of self-care
should be a professional expectation inherent to the role of
nurses. This warrants consideration. The importance of
nurses’ self-care is evident in the International Council
of Nurses’ (ICN) competency standards for general registered nurses (Alexander and Runciman, 2003). However,
corresponding standards in individual countries do not
necessarily align with those of the ICN. In the UK for
example, the importance of self-care for nurses is not
evident in the Nursing and Midwifery Council’s (2010)
Standards for competence for registered nurses framework.
Nor is it evident in practice standards for registered nurses
in other countries such as New Zealand (Nursing Council of
New Zealand, 2007), Canada (The College of Nurses
Ontario, 2014), and the Philippines (Philippine Nurses
Association, 2012). The problem of neglecting self-care
for nurses within practice standards has also been
identiﬁed in Korea (Shin and Eschiti, 2005).
The workforce literature shows the importance of selfcare for all nurses, but these discrepancies suggest that this
is not recognised consistently. This raises implications for
the global development of nursing practice standards, or
revision of existing standards that lack self-care content.
While socio-political factors are likely to be inﬂuential in
each country, without decisive action to promote the
importance of self-care, it is likely to remain poorly visible
and undervalued in nursing. Maben (2008) identiﬁed that
the importance of nurses’ caring work, in general, is often
invisible and subordinated. Therefore, the imperative here
is to make the importance of self-care visible and more
valued in practice. It is questionable whether nurses will
practice self-care if they are not explicitly trained or
required to do so. But it is also uncertain whether the
inclusion of self-care in education and practice standards
would be effective, if nurses lack capacity to be kind to
themselves through self-compassion.
Neff (2003) pioneered research into self-compassion,
based on Buddhist psychology that considers compassion
for self as equally important to compassion for others. As
a construct, self-compassion was operationalised through
the development and validation of a scale to measure its
components of self-kindness, mindfulness, and common
humanity (Neff, 2003). According to Germer (2009, p. 33)
self-compassion is ‘‘simply giving the same kindness to
ourselves that we would give to others.’’ Comprehensive
studies have linked self-compassion with increased compassion for others (Jazaieri et al., 2013; Neff and Germer,
2013; Neff and Pommier, 2013), in addition to resilience and
emotional intelligence (Heffernan et al., 2010; Neff and
McGehee, 2010), and other pro-social behaviours (Neff et
al., 2007). Self-compassion has been found to be distinct
from, and not associated with, narcissism (Leary et al.,
2007). Moreover, randomised controlled trials have established that training interventions can increase compassion
and self-compassion in certain populations (Jazaieri et al.,
2013; Neff and Germer, 2013). But the vast majority of selfcompassion studies to date have originated from the
discipline of psychology and non-clinician populations.
Research into self-compassion has only recently begun to
appear in the health professional domain.
Of only three known studies to investigate selfcompassion in nurses, two demonstrated a positive
correlation with emotional intelligence in both nurses
and student nurses (Heffernan et al., 2010; S¸enyuva et al.,
2013); while the third explored clinical educators’
understanding of self-compassion as a source for compassionate care (Gustin and Wagner, 2013). There is emerging
evidence to suggest a relationship between nurses’ selfcompassion and compassionate care for patients. However, it is important to consider the organisational environment within which compassionate care is provided.
In a nursing context, compassion has been observed to
be subtle, and yet, distinctly palpable in its beneﬁt to both
individuals and organisations (Frost, 1999). But to what
extent can nurses be expected to provide compassionate
care, if their workplaces are not compassionate? Dutton et
al. (2008, p. 110) argue that ‘‘as human institutions,
organisations are sites that inevitably harbour the
emotional pain and suffering of their individual members.’’
Therefore, compassionate leadership is vital. While some
emphasise compassion at an individual level within
organisations (Atkins and Parker, 2012), others underscore
the importance of shared responsibility and organisational
leadership (Scott, 2014; Straughair, 2012). Compassion is
central to the practice of leadership (Georges, 2011). The
primacy of compassion—for self and others—must be
engendered within, and not merely espoused by, healthcare organisations. To this end, Crawford et al. (2014)
highlight the need for management, policymakers and
professional bodies to foster organisational environments
conducive to compassion. Within these environments,
nurses can better embody the compassionate care that is
expected of nursing as a caring profession.
Self-care is not selﬁsh. For the wellbeing and congruence of nurses—as educators and health promotion
advocates—it is essential. Similarly, self-compassion is
not narcissistic. Rather, it is a foundation for compassionate care. But further research is needed: ﬁrstly to examine
the inﬂuence of the relationship between self-compassion
and self-care in nurses; then to test its relationship to
compassionate care for patients. This emerging line of
inquiry in nursing practice can serve to progress the
imperative of compassionate care towards a compassion
that is more genuine.
Acknowledgement
The ﬁrst author is supported by an Australian Postgraduate Award from The University of Sydney.
Conﬂict of interest: None declared.
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Jason Mills*
Timothy Wand
Jennifer A. Fraser
Sydney Nursing School,
The University of Sydney, New South Wales 2050, Australia
*Corresponding author at: Sydney Nursing School,
The University of Sydney, Camperdown, New South Wales
2050, Australia. Tel.: +61 2 408 587 577
E-mail address: [email protected]
Received 9 October 2014